ADHD meds for 6 year old who's anxious

[Becca0512]

Hi all,
We had an ADHD diagnosis (privately) for our 6 year old at Easter and have been trialling meds. He is also quite an anxious/ worried child (possibly has ASD but hasn't been assessed)

We tried methylphenidate (medikinet XL and IR) started at 5mg, noticed not improvement up to 10mg, school noticed an improvement but the rebound was awful at 4pm. Told our clinician and she was keen to try 15mg with a 5mg IR at lunchtime to try and get him through the rebound ...........what followed was 10 days of hell. So many temper tantrums, mood swings, irritability etc. Told the clinician and she advised we try Elvanse instead, 20mg but advised could half the dose if needed, tried the 20mg and gave it at 7am (we knew it came last 12-14 hours), we had such a bad day, he was really anxious (convinced himself our cat was going to die that day) was meant to go on a playdate and got him to my work where he was being collected and he laid in the carpark crying his eyes out saying he didn't want to go, he eventually went but 2 hours into the playdate I had to leave work to get him because he went out on a bike ride and halfway round had a meltdown, got off the bike and refused to move. The day was a disaster and bedtime was hell, had to give him double of his XL melatonin and 2 IR melatonin and still didn't go to bed until gone 10pm. We gave him the next couple of days off then decided to try the 10mg but gave it at 6am, had it for 2 days and a bit up and down but not as bad but still very anxious. He told me "my brain feels wobbly" 😔

We've not really given it since because it has to be given so early in the morning or he's up till silly late at night. He already has massive sleep disturbances (can often be up for 2+ hours a night and needs IR melatonin to get back to sleep then will sleep in until 630-7)

I'm keen to try atomoxteine because I've read that it can be really good for anxiety and then maybe add the 10mg medikinet XL back in once the atomoxteine is built up in his system to help him through the school day if needed (the 10mg was great for school, no more fidgeting, able to concentrate etc) but the rebound was alot to deal with but I think the atomoxteine should cover that?

Also, thoughts on supplements? Zinc, iron for ferritin levels and magnesium (we have had him on magnesium for a while now to try and help with sleep) also anyone have any knowledge of 5-htp for ADHD? I take it to help with my anxiety and stress levels but think it might be contraindicated with atomoxteine due to risk or serotonin syndrome.

I'm also aware that he might not respond to any meds yet and might need to wait a year or so and try again but I'm worried about his schooling, he was starting to slip behind and really just want the best for him.

Any advice or experience would be great

Thanks

What is his behaviour like off meds OP? He's very young and I wouldn't be happy with mine basically being a guinea pig like this at just 6. It sounds like he's on a whole cocktail of stuff, some of which is having a terrible effect, and that doesn't sound like the best thing for him. Even melatonin is a hormone with unknown long term effects that has been poorly researched. I'm certainly not against meds for ADHD because they can be life changing - but this feels like too much, too young to me. For me I'd be looking at much more practical ways to help and support him at this age.

Does he sit right at the front of the class for input if he is easily distracted/can't filter out distractions for example? does he have access to ear defenders if he needs to concentrate and block out noise at school (if he'll wear them)? does he get warnings between transitions? Is he getting lots of help with any homework at home to make sure he understands? Does he have a clear routine that he knows in advance? Is he being taught simple coping strategies for anxiety and being encouraged with resilience, being allowed to lose or do badly and seeing that this is ok and all part of learning? Is he being read to and someone listening to him read everyday? Is screen time limited and none for at least an hour before bed time? Does he have a long wind down routine of 30-60 minutes before bed time? Is he getting plenty of chance to exercise and burn off steam every day?

Maybe this is all already happening, but at this age I'd be concentrating on finding ways to enable him to cope as much as possible rather than medicate him. Mine has ASD rather than ADHD though so it is different but making adjustments that helped made such a difference when he was young.

@Cat3059 off meds he is very hyperactive, impulse, has risk taking behaviour and has massive sleep disturbances.

The school are very supportive and provide him with movement breaks, put him on the end of lines on the carpet so he can move around. They don't penalise him because of his ADHD but he is struggling to focus and concentrate and it's making him fall behind and he is not hitting his markers.

I don't think he's being used as a guinea pig, it's known that it can take alot of trial and error to find the right medication/ dose and what works for one child might not for another. There is alot of research rhT shows if diagnosed and medicated earlier in life (from 6), children show better outcomes in school, emotional regulation and even had better grey matter (help in memory, emotions and movement) in their brains after medicating when scans were taken before and after.

We have very strict routines in place for him and prep before transitions. A wind down routine is very hard to achieve when an he is literally running around the house buzzing with energy. He gets outside as often as the weather allows, we walk/ cycle the 20 minutes to and from the school most days. We are waiting on referral for CBT to help him with coping strategies and with his anxiety. We do all we can at home but it's like groundhog day, we try to teach him but it doesn't stick and we are right back at the same thing the next day.

I don't medicate him lightly, it wasn't an easy decision but we want the best for him and his schooling and emotional development. He is becoming aware that he's "different" to some of the children that we know and that he struggles with things his friends don't struggle with.

It's heartbreaking to see him struggle with his peers.

The melatonin was prescribed because we had 2 years of multiple wake ups a night lasting up to 3.5 hours and no-one was unable to function during the day.

We are trying to do all we can but I think he needs a combination of that and medication for him to process the world around him and learn to regulate his emotions. We can cope with him without medication but the ADHD behaviours are getting worse and makes everything a struggle to be honest.

Thanks for your input

You mentioned possible autism - ADHD meds can make autism more obvious, and your child got the diagnosis very young. Does he do sports every day, regardless of the weather? Did he have an OT sensory assessment?

CBT at this age will be mainly working with parents to support your child, look at triggers, zones of regulation etc. Do you have supports for yourself in place, friends, family, other SEN parents?